Updated nutrition assessment form now available for home infusion providers
An updated Enteral and TPN Nutrition Assessment / Follow-up Form is now available. This form is intended for use only by home infusion providers
Where to get the form. The form opens from the Forms page on this website. At the bottom of the page, under the "Transitional Care Services" heading, click to open the form.
What's changed. The updated Enteral and TPN Nutrition Assessment / Follow-up Form:
- Has fields into which you can type the information about your agency and the patient. Open the form and save it to your hard drive. Then type the data into the fields.
- Includes information for patients getting total parenteral nutrition feedings as well as enteral feedings
- Shows two different fax numbers – one for BCN HMOSM (commercial) members and one for BCN AdvantageSM members. Faxing the form to BCN using the appropriate fax number will help facilitate your request.
What's important to know. Be aware that:
- The home infusion agency's name, contact person and contact number must be entered into the form. Without that information, BCN cannot complete the authorization process and get the authorization decision back to you in timely fashion.
- You must provide the start-of-care date. That date may be different from the assessment date and the date the form is submitted.
- Enteral and TPN feeding services must be provided by an infusion provider contracted with BCN. You can search for an infusion provider by visiting bcbsm.com/find-a-doctor.
- It is BCN, not Northwood, Inc., that receives and processes requests to authorize home infusion services. The fax numbers you'll use to return the completed form go to BCN, not to Northwood.
What about after-hours calls? If you require discharge planning assistance after hours or on weekends or holidays, contact BCN's after-hours nurse at 1-800-851-3904.
Posted: March 2016
Line of business: Blue Care Network